Menopause

What is Menopause?
Menopause is the medical term for the end of a woman’s menstrual periods. It is often called the "change of life" and marks the transition between a woman’s childbearing years and her non-childbearing years. Menopause is a natural part of aging and occurs as a result of the gradual loss of estrogen, a hormone produced in the ovaries. During a period known as "perimenopause," estrogen production declines and women often develop irregular periods, hot flashes, mood swings and fatigue. These symptoms often develop 3 to 5 years before a woman’s last period. Menopause is diagnosed when a woman has been without a period for one year.

The average age of menopause is 51 but varies from person to person. Cigarette smoking has been shown to accelerate the onset of menopause by 1-2 years. A variety of factors that affect ovarian function may cause premature menopause.

Menopause in African American Women

Menopause affects all women regardless of race or socioeconomic background. However, recent studies have shown that the experience of menopause is different among racial groups. African Americans have more estrogen related symptoms (hot flashes, night sweats, vaginal dryness, urine leakage) than all other ethnic groups. Additionally, African Americans are less likely to have somatic symptoms (headaches, difficulty sleeping, racing heart, stiffness and soreness in joints) than all other ethnic groups.

What are the Signs and Symptoms of Menopause?

Menopause is a very individualized experience. Some women find the "change" extremely bothersome while others notice little difference. Research has proven, however, that low estrogen levels are responsible for a variety of uncomfortable symptoms, which will be outlined below.

Hot Flashes: Hot flashes are the most common symptom of menopause, affecting more than 60 percent of menopausal women. A hot flash is a sudden; often fleeting sensation ranging from warmth to intense heat that usually begins in the face or upper chest and spreads over the body. These flashes usually last from 30 seconds to several minutes, and are often accompanied by a rapid heart rate and feelings of anxiety. Hot flashes usually occur spontaneously but can be triggered by hot, humid weather, confining spaces or ingestion of caffeine, alcohol or spicy foods. Stress and tension may also increase the frequency and severity of flashes.

Irregular Menstrual Periods: Episodes of heavy bleeding and/or of infrequent cycles. Cycles may be longer or shorter. Irregular menstrual cycles may occur 2-8 years before the end of your periods. However, not all cases of irregular bleeding are caused by menopause. Discussion with your physician will determine if further evaluation is necessary.

Mood Changes: many women report an increased level of anxiety and irritability as the "change" occurs.

Vaginal Dryness: results from lack of vaginal lubrication. This is caused by a deficiency of estrogen and may contribute to a decrease in sexual satisfaction.

Complications of Menopause

We have already discussed many of the changes a woman goes through during menopause. It is important to realize that there are long-term complications linked to the decreased levels of estrogen that accompany menopause. We will discuss the most important ones below.

Osteoporosis: (thinning of the bones) Deficiency of estrogen results in loss of bone mass. A decrease in bone mass may lead to curvature of the spine, fractures of the vertebrae, loss of height and pain.

Cardiovascular Disease: Many studies have shown that the risk of cardiovascular disease, including heart attacks and strokes, are increased in postmenopausal women. This is thought to be caused by estrogen related changes in levels of cholesterol and other blood lipids (fats).

Vaginal/Urinary Changes: vaginal tissues and tissues of the bladder are estrogen sensitive. Without estrogen, these tissues start to degenerate, resulting in symptoms of vaginal dryness, painful intercourse, painful urination and incontinence.

How can you be evaluated for Menopause?

Menopause is diagnosed primarily by its symptoms. If a woman who is almost 50 years old or older stops menstruating completely, a presumptive diagnosis of menopause can be made without further testing. Diagnosis is slightly different in a younger woman who has signs and symptoms of menopause. Special hormonal blood tests may be necessary to confirm the diagnosis. Your doctor will be happy to discuss this with you further.

Treatment Options

Hormone Replacement Therapy (HRT): As stated earlier, many of the symptoms and complications of menopause occur as the result of a deficiency in estrogen. Most women will eventually need to decide whether or not to take hormone replacement therapy (HRT). HRT can have beneficial effects for many women, but it is not for everyone. For further information, go to our section on hormone replacement therapy.

Calcium supplementation for prevention of osteoporosis. Postmenopausal women on HRT should take 1,000 mg of calcium daily. Women not on HRT should take 1,500 mg of calcium daily. Ask your physician regarding other bone sparing medications including vitamin D, and phosphorous containing medications.

Nutrition: Eating a reasonable diet will help you throughout and after menopause. Choose foods low in fat, saturated fat and cholesterol. Eat fruits, vegetables and whole grain cereal products, especially those high in vitamin c and carotene. Eat very little salt-cured and smoked foods such as sausages, smoked fish and ham, bacon and hot dogs. Avoid food and drinks containing processed sugar.

Exercise: Regular exercise benefits the heart and bones, helps regulate weight and contributes to a sense of overall well-being and improvement in mood. Weight bearing exercises such as walking and running help to increase bone mass. Moderate exercise preserves bone mass in the spine, helping reduce the risk of fractures. Consult your doctor before starting a rigorous exercise program. He or she will help you decide which types of exercises are best for you. An exercise program should start slowly and build up to more strenuous activities.

Empowerment Points

Menopause should be considered a naturally occurring event in all women’s lives. It is a time of transition. It is not an end to life or of normalcy!

Symptoms of menopause can include hot flashes, irregular menstrual periods, mood changes, disrupted sleep, vaginal dryness and changes in urinary continence.

Making lifestyle changes such as improving your diet and exercise can make a significant difference in menopausal symptoms.

Do not be afraid to talk with your doctor regarding your concerns about menopause. There are many therapies that may help.